Mental Health Consequences of War, Internal Conflict and Disrupting Living Conditions : The Case of Afghanistan

The Soviet occupation, the reign of terror under the Taliban and the armed conflict since 2001 have deeply scarred the Afghan nation and its people. The majority of Afghans face a set of permanent stressors and have to deal with painful and burdensome experiences and losses which often elicit somatic and psychosocial symptoms. At the same time, Afghan men and women almost invariably lack awareness and conceptual knowledge of psychological processes. In particular, the mental health consequences of stressful living conditions and traumatic memories, which they experience as being etched into their body, mind and soul, are unconscious to them. This condition evokes a feeling of helplessness in the people. Until recently, the Afghan public health system did not provide any mental health services. The population also did not receive any support in coping with the resource poor living conditions. In consequence, the breeding ground for further conflicts within families and the society grew.

This situation served as the starting point of the present doctoral thesis. The research project aimed to systematically investigate the psychosocial consequences of living in an area of war and crisis by using the example of Afghanistan. For this purpose, it covers Afghans who still live in the burdensome living conditions of their home country and Afghans who decided to escape the situation and managed to flee to Germany in order to start a new life there. Furthermore, the doctoral thesis investigates in a randomised trial the efficacy of a psychosocial counselling approach which has recently been integrated into the Afghan public health system.

The studies conducted in Afghanistan point out the high prevalence of mental health problems within the population. In particular, high rates of symptoms of depression and anxiety were found. The interviewed Afghan women reported a number of psychosocial stressors, such as poverty, domestic violence and family conflicts. The daily real fear as well as the insecurity and uncontrollability of the present situation often led to a traumatic stress reaction, which was delineated from the classic notion of PTSD. This sparked the idea of developing the concept of a “continuous traumatic stress” situation, which takes into consideration the time variable.

The randomised trial investigating the efficacy of psychosocial counselling conducted in a health facility in Northern Afghanistan showed a significant reduction of mental health symptoms and psychosocial stressors in counselled Afghan women.

A further study assessing the mental health status of asylum-seekers and refugees in Germany who had experienced the war in Afghanistan showed lower rates of symptoms of depression and anxiety. The participants in Germany reported less and different psychosocial stressors than people assessed in Afghanistan. Remarkably, Afghan women living in Germany reported significantly lower rates of domestic violence than those being interviewed in Afghanistan. At the same time, the study showed that Afghan men and women who live in Germany perceive the immigration process as exceedingly stressful.

In sum, the present doctoral thesis demonstrates that the support of the Afghan health system plays a vital role in building up a civil society. The studies showed that the access to a qualified and profound mental health service is a precondition for regaining psychological functioning, coping with painful experiences and finally establishing healthy relationships within the family and the community.

2013Mental Health Consequences of War, Internal Conflict and Disrupting Living Conditions : The Case of AfghanistanAyoughi, SarahThe Soviet occupation, the reign of terror under the Taliban and the armed conflict since 2001 have deeply scarred the Afghan nation and its people. The majority of Afghans face a set of permanent stressors and have to deal with painful and burdensome experiences and losses which often elicit somatic and psychosocial symptoms. At the same time, Afghan men and women almost invariably lack awareness and conceptual knowledge of psychological processes. In particular, the mental health consequences of stressful living conditions and traumatic memories, which they experience as being etched into their body, mind and soul, are unconscious to them. This condition evokes a feeling of helplessness in the people. Until recently, the Afghan public health system did not provide any mental health services. The population also did not receive any support in coping with the resource poor living conditions. In consequence, the breeding ground for further conflicts within families and the society grew.<br /><br />This situation served as the starting point of the present doctoral thesis. The research project aimed to systematically investigate the psychosocial consequences of living in an area of war and crisis by using the example of Afghanistan. For this purpose, it covers Afghans who still live in the burdensome living conditions of their home country and Afghans who decided to escape the situation and managed to flee to Germany in order to start a new life there. Furthermore, the doctoral thesis investigates in a randomised trial the efficacy of a psychosocial counselling approach which has recently been integrated into the Afghan public health system.<br /><br />The studies conducted in Afghanistan point out the high prevalence of mental health problems within the population. In particular, high rates of symptoms of depression and anxiety were found. The interviewed Afghan women reported a number of psychosocial stressors, such as poverty, domestic violence and family conflicts. The daily real fear as well as the insecurity and uncontrollability of the present situation often led to a traumatic stress reaction, which was delineated from the classic notion of PTSD. This sparked the idea of developing the concept of a “continuous traumatic stress” situation, which takes into consideration the time variable.<br /><br />The randomised trial investigating the efficacy of psychosocial counselling conducted in a health facility in Northern Afghanistan showed a significant reduction of mental health symptoms and psychosocial stressors in counselled Afghan women.<br /><br />A further study assessing the mental health status of asylum-seekers and refugees in Germany who had experienced the war in Afghanistan showed lower rates of symptoms of depression and anxiety. The participants in Germany reported less and different psychosocial stressors than people assessed in Afghanistan. Remarkably, Afghan women living in Germany reported significantly lower rates of domestic violence than those being interviewed in Afghanistan. At the same time, the study showed that Afghan men and women who live in Germany perceive the immigration process as exceedingly stressful.<br /><br />In sum, the present doctoral thesis demonstrates that the support of the Afghan health system plays a vital role in building up a civil society. The studies showed that the access to a qualified and profound mental health service is a precondition for regaining psychological functioning, coping with painful experiences and finally establishing healthy relationships within the family and the community.Ayoughi, Sarah2013-09-12T10:07:56Zdeposit-licenseeng2013-09-12T10:07:56Z